MICROSCOPIC SATELLITES OF MALIGNANT-MELANOMA AND CONSEQUENCES FOR SURGICAL-TREATMENT

Immediate and complete surgical excision is the standard mode of treat ment for primary malignant melanoma. There is still a controversy abou t the adequate resection margins. In this study we looked for microsco pic satellites in order to estimate the extent of local therapy. Metho d: 19 patients with malignant melanoma of the trunk or extremities, tr eated by wide excision- were included. Clinical courses were documente d. Postoperative follow-up was 1.4 years in the mean. In primary tumou rs and cutaneous excisions we looked for microscopic satellites with r outine histology and immunohistochemistry (APAAP-technique, monoclonal antibody HMB-45). Results: Using APAAP-technique in combination with routine histology, we could show that microscopic satellites only occu rred in specimens of melanomas of more than 5 mm thickness. In the two cases where evident microscopic satellites were present a systemic di ssemination obviously evolved already before the first surgical treatm ent. Therefore, in those cases wide resection margins do not provide a n increasing chance of survival. Conclusion: The idea to remove micros copic satellites by wide surgical excisions and thus to reduce the ris k fur systemic dissemination and local recurrence cannot be supported.